The effects of orchiectomy and steroid on fertility in experimental testicular atrophy.

OBJECTIVE: Despite our understanding of Sertoli cell function and the state of spermatogenesis, the underlying mechanisms remain unclear. This study was conducted to compare the effects of orchiectomy and steroid treatment on fertility in testicular atrophy occurring after testicular torsion. METHODS: Thirty-three rats were divided into four groups. The atrophy, orchiectomy, and atrophy-steroid groups each contained nine rats, while the control group contained six. The left testes were rotated 720º, and atrophy was observed. In the atrophy-steroid rats, orchiectomy was performed after atrophy, and 1 mg/kg steroid was injected. Each male rat was housed with five female rats for 6 days. The fertility of the male rats was evaluated based on the pregnancy of the female rats. Left and right orchiectomies were performed to determine the tissue Johnsen score (JS) and the serum inhibin B (IB) level. RESULTS: JS values were significantly lower in the atrophy, orchiectomy, and atrophy-steroid groups than in the control group (p<0.05), while no significant difference was observed in JS between the atrophy and orchiectomy groups (p>0.05). Similarly, no significant differences in IB level or fertility percentage were found between the atrophy and orchiectomy rats (p>0.05). CONCLUSION: In unilateral testicular atrophy, which can occur in the prepubertal period due to various causes, orchiectomy does not appear to benefit fertility, as indicated by IB, JS, and the fertility percentage.

A rare presentation: Penile agenesis, vesicoureteral reflux, and rectovesical fistula in a newborn.

The penis is an important organ in fertility, urinary and psychosexual structure of males. Complete penile agenesis is a rare congenital genitourinary anomaly and is usually associated with other malformations such as gastrointestinal, cardiac, and musculoskeletal lesions. Although many uncommon types have been reported, penile agenesis associated with vesicoureteral reflux has not been reported in an infant with vesicorectal fistula. This is the first report of an infant with the combination of penile agenesis, vesicoureteral reflux, and vesicorectal fistula. A three-year-old infant with penile agenesis proven to have bilateral vesicoureteral reflux and vesicorectal fistula is reported.

The effect of epidermal growth factor applied locally for pelviureteral anastomoses.

OBJECTIVE: To investigate the effect of epidermal growth factor (EGF) on fibrous tissue formation and wound healing in experimental pelviureteral anastomosis (PUA). MATERIALS AND METHODS: Twelve rabbits were divided equally into 2 groups: control (C) and epidermal growth factor (EGF). A 1-cm length of the ureteropelvic segment was resected through a laparotomy incision and then anastomosis was performed. The rabbits were administered locally with 100 µg/kg EGF (EGF group) all around the anastomosis lines after the surgical procedure. The C group did not receive any medication during their procedure. Intravenous pyelography was carried out on postoperative day 21. The rabbits were sacrificed and dissected under a dissecting microscope and examined for acute inflammation (AI), chronic inflammation (CI), granulation tissue amount (GTA), granulation tissue fibroblast maturation (GTFM), collagen deposition (CD), neovascularization (N), re-epithelization (R), and peripheral tissue reaction (PTR) in the anastomosis lines 3 weeks later. RESULTS: There were no significant differences in the GTA, N, or R scores in the C group compared with those in the EGF group. In the EGF group, AI and CI scores were lower than they were in the C group. CD, GTFM, and PTR in the EGF group were higher than they were in the C group. CONCLUSION: EGF did not decrease CD, GTFM, or PTR, but did decrease important parameters in wound healing such as acute inflammation and chronic inflammation in an experimental model of PUA in rabbits.

The effect of natrium hyaluronate applied locally for pelviureteral anastomoses.

OBJECTIVES: This study aimed to investigate the effect of natrium hyaluronate (NH) on fibrous tissue formation and wound healing in experimental pelviureteral anastomosis (PUA). MATERIALS AND METHODS: Eighteen rabbits were divided equally into three groups: surgical (S), sham (Sh), and NH. A 1-cm length of the ureteropelvic segment was resected through a laparotomy incision and then anastomosis was performed. The rabbits were injected with saline (Sh group) and NH (NH group) into anastomoses lines after the surgical procedure. The S group did not receive any medication during their procedure. Intravenous pyelography was carried out on postoperative day 21. The rabbits were sacrificed and dissected under a dissecting microscope and examined for acute inflammation (AI), chronic inflammation (CI), granulation tissue amount (GTA), granulation tissue fibroblast maturation (GTFM), collagen deposition (CD), neovascularization (N), re-epithelialization (R), and peripheral tissue reaction (PTR) in the anastomosis lines 3 weeks later. MAIN FINDINGS: There were no significant differences in the GTFM scores in the S group compared with those in the NH group. In the NH group, N scores were higher than they were in the S group. Re-epithelialization in the NH group was higher than it was in the S group. PRINCIPLE CONCLUSIONS: NH did not decrease fibrosis, but increased important parameters in wound healing such as neovascularization and re-epithelialization in an experimental model of PUA in rabbits.

Immunohistochemical and morphometric evaluation of neuronal dysfunction in pelviureteral junction obstruction.

PURPOSE: The pathophysiology of pelviureteral junction obstruction remains unclear. In this study, we attempted to evaluate the neuronal dysfunction using immunohistochemical and morphometric parameters. MATERIALS AND METHODS: Using specific antibodies, we studied the neuronal markers and morphometry of specimens from 10 cases of pelviureteral junction obstruction and 10 normal pelviureteral junctions by immunohistochemistry using synaptophysin (synaptic vesicle membrane protein), S-100 (nerve cell fiber marker), protein gene product 9.5 (neuron specific protein) and CD-117 (transmembrane receptor with tyrosine kinase activity). RESULTS: In pelviureteral junction obstruction, smooth muscle thickness was significantly higher than in normal specimens. Cytoplasmic cells stained by synaptophysin were found in the pelviureteral junction obstruction specimens but were absent in normal pelviureteral junction specimens. In addition, significantly more intense staining for S-100 was found in the pelviureteral junction obstruction specimens compared with the normal specimens. Immunohistochemical staining for protein gene product 9.5 showed no differences between the normal and pelviureteral junction obstruction specimens. Neither the normal specimens nor pelviureteral junction obstruction groups were stained by CD-117. CONCLUSION: We propose that the cause of neuronal dysfunction in pelviureteral junction obstruction depends on the increase in number and structure of neuronal cells and smooth muscle thickness. These factors could play an important role in the pathophysiology of pelviureteral junction obstruction by affecting motility and peristalsis.

Surgical management with or without a nasogastric tube in esophageal repairs.

OBJECTIVE: The aim of the study was to compare surgical management with or without a nasogastric tube (NGT) to prevent anastomotic stricture that occurred following esophageal repairs (ERs). METHODS: Twelve New Zealand rabbits were divided equally into 2m: with a NGT (experimental group) and without a NGT (control group). A 1-cm-length of the cervical esophagus was resected through a cervical incision and then anastomosis was performed using the NGT and keeping it in place for 6 days in the experimental group. The same procedures were performed in the control group. Both groups were fed parenterally for 6 days and orally after esophagography on postoperative day 7 as long as there was no esophageal leakage. The rabbits were sacrificed to evaluate diameter of the esophageal lumen (DOTEL), bursting pressure (BP), tissue hydroxyproline (HP) and wound healing scores (WHSs) in the anastomosis lines 8 weeks later. RESULTS: In the experimental group, DOTEL, BP, and HP were significantly lower than they were in the control group. WHSs in the experimental group were not higher than they were in the control group. CONCLUSIONS: Surgical management without a NGT is more effective than management with a NGT in ERs as shown by increased DOTEL, BP, and HP levels.

The effects of early and late feeding on healing of esophageal anastomoses: an experimental study.

OBJECTIVE: To investigate the effects of postoperative late and early feeding on the healing of experimental esophageal anastomosis (EA). METHODS: Twelve New Zealand rabbits were divided equally into 2 groups: late feeding (LF) and early feeding (EF). A 1-cm-length of the cervical esophagus was resected through a cervical incision, and then anastomosis was performed. The LF group was fed parenterally for 6 days and orally (per oral route) after esophagography on postoperative day 7 as long as there was no esophageal leakage. The EF group was fed orally (per oral route) 24h after esophageal repairs (ERs), and esophagography was carried out on postoperative day 7 to check the ERs. The rabbits were sacrificed to evaluate bursting pressure (BP), diameter of the esophageal lumen (DOTEL), tissue hydroxyproline (HP), and wound healing scores (WHSs) in the anastomosis lines 8 weeks later. RESULTS: In the LF group, BP and DOTEL were significantly lower than they were in the EF group, and HP was significantly higher than it was in the EF group. WHSs in the LF group were not higher than they were in the EFgroup. CONCLUSIONS: Early feeding is superior after EA as shown by increased DOTEL and BP levels, but causes decreased HP levels.

Investigation of histopathologic changes in pelviureteral junction obstruction.

OBJECTIVES: This study aimed to determine histopathologic changes in the pelviureteral junction in children with pelviureteral junction obstruction. MATERIAL AND METHODS: Seventeen pelviureteral junction specimens obtained from children were divided into two groups: pelviureteral junction obstruction (n = 7) and control (n = 10). Wall thickness of the pelviureteral junction, tunica muscularis of the pelviureteral junction, uroepithelium thickness of the pelviureteral junction, and collagen thickness of the pelviureteral junction were evaluated in resected pelviureteral junctions in children with pelviureteral junction obstruction. MAIN FINDINGS: The mean wall thickness of the pelviureteral junction, mean tunica muscularis of the pelviureteral junction, and uroepithelium thickness of the pelviureteral junction were not significantly higher than those in the control group. Collagen thickness values in the pelviureteral junction obstruction group were significantly higher than those in the control group. CONCLUSIONS: Our data suggest that wall thickness (tunica muscularis and uroepithelium) was not significantly increased, but collagen thickness of the ureter was increased in the pelviureteral junctions of children with pelviureteral junction obstruction.

Colon agenesis with ileovesical fistula and anorectal malformation.

Colonic agenesis is a rare cause of congenital bowel obstruction and is usually associated with other malformations such as abdominal wall defects or gastrointestinal, cardiac, urogenital, and musculoskeletal lesions. Although many uncommon types have been reported, ileovesical fistula (IVF) associated with total colonic agenesis (TCA) has not been reported in a newborn with anorectal malformation (ARM). This is the first report of a 1-day-old newborn with ARM, IVF, and TCA.

The healing effects of tissue glues and healing agent locally applied on esophageal anastomoses.

OBJECTIVE: This study aimed to investigate the effects of cyanoacrylate (C), fibrin glue (FG), and natrium hyaluronate (NH) on the healing of esophageal anastomosis (EA). METHODS: Twenty-four rabbits were divided equally into 4 groups: primary anastomosis (PA), C, FG, and NH. A 1-cm-length of the cervical esophagus was resected through a cervical incision and then anastomosis was performed. C, FG, and NH were instilled into anastomosis lines in the respective groups. The animals were fed orally on postoperative day 7 on the condition that there was no esophageal leakage. The rabbits were sacrificed 8 weeks later to evaluate bursting pressure (BP), tissue hydroxyproline (HP) levels and wound healing scores (WHSs) in the anastomosis lines. RESULTS: BP was significantly higher in the C group than in the PA, FG, and NH groups, and HP was significantly lower than in the other groups. WHSs in the PA and NH groups were lower than in the C and FG groups. CONCLUSIONS: C and NH appear to be beneficial in EA healing with respect to increased BP and decreased HP when they are used simultaneously with PA prophylactically to prevent esophageal leakages and stricture.

Migration of intra-articular K-wire into the contralateral pelvis after surgery for developmental dysplasia of the hip: a case report.

Transarticular fixation of femoral head into acetabulum with K-wire is a seldomly used surgical method in difficult cases of developmental dysplasia of the hip (DDH). This paper presents a child with intrapelvic transvesicular migration of a K-wire without any symptoms after treatment of DDH. Eight years old girl who had multiple surgeries 4 years ago due to bilateral DDH applied to the orthopedics clinic with limping. She had good range of motion of both hips. At the pelvis radiograph, there was an intrapelvic K-wire standing between two hemipelvises like a bridge. She did not have any enteral and urological symptoms after the previous operations. We planned to remove the K-wire in cooperation with the pediatric surgery department. On the cystoscopy, K-wire was seen passing through the urinary bladder. Wire was cut at the middle point and taken out of the body by laparotomy. The patient was discharged without any postoperative complications. K-wire retention in the body has high chance of migration. Early postoperative removal of the K-wire is necessary to prevent possible complications.

Effects of fasting and preoperative feeding in children.

AIM: To investigate whether children should undergo surgery without a long period of fasting after feeding. METHODS: Eighty children with inguinoscrotal disorders (aged 1-10 years) were studied prospectively. They were divided into eight groups that each contained 10 children who were fed normal liquid food (NLF) and a high-calorie diet (HCD) 2, 3, 4 and 5 h before surgery, in two doses at 6-h intervals. NLF was given to four groups and HCD to the other four. In all groups, glucose, prealbumin and cortisol levels in the blood were measured twice: just after oral feeding and just before the operation. After the establishment of adequate anesthesia, gastric residue liquid was measured with a syringe. RESULTS: Blood glucose levels in all patients fed NLF and HCD were high, except in patients in the HCD-4 group. There was no significant difference in the blood prealbumin levels. There was a significant increase in the blood cortisol levels in the NLF-2 (14.4 +/- 5.7), HCD-2 (13.2 +/- 6.0), NLF-3 (10.9 +/- 6.4), and HCD-5 (6.8 +/- 5.7) groups (P < 0.05). CONCLUSION: The stress of surgery may be tolerated by children when they are fed up to 2 h before elective surgery.

Efficacy of antioxidant treatment in the prevention of testicular atrophy in experimental testicular torsion.

BACKGROUND/PURPOSE: This study aimed to compare dose schedules of the antioxidant treatment (melatonin and steroid) used as 1 dose and as once a day for 7 days in terms of salvage of the testes in the late period. METHODS: Sixty prepubertal rats were divided into 6 groups each containing 10 rats: sham (S), torsion-detorsion (TD), 1-dose melatonin (M(1)), 1-dose steroid (ST(1)), 7-dose melatonin (M(7)), and 7-dose steroid (ST(7)) groups. The left testes were rotated 720 degrees for 6 hours and detorsed for 6 hours thereafter. In the treatment groups, 17 mg/kg melatonin and 1 mg/kg steroid were injected 15 minutes before detorsion. Left orchiectomies were performed to determine testicular weights and Johnsen scores 3 months later. RESULTS: Testicular weights and Johnsen scores in the M(1), ST(1), and TD groups were significantly lower compared with those in the S group, and atrophy developed in these groups, whereas they were higher in the M(7) and ST(7) groups compared with the TD group. Testicular atrophy did not develop in the M(7) or ST(7) groups. CONCLUSIONS: Our results suggested that antioxidant agents used once a day for 7 days prevent testicular atrophy and are effective in terms of salvage of the testes.

The effect of cyanoacrylate in esophagocutaneous leakages occurring after esophageal anastomosis.

OBJECTIVE: Esophageal leakage (EL) continues to be a challenging pediatric surgical problem. The aim of this study was to investigate the effect of cyanoacrylate (Cy) in EL followed esophageal repair (ER). METHODS: Twelve rabbits were divided into control (C) and leakage (L) groups. A 1cm-length transverse esophageal incision at the level of the cervical region was made. In both groups, feeding was started orally 24h after the surgery for leakage creation. On postoperative day 7, primary repair was carried out in the C group and Cy instillation was performed in the L group. Esophagographic analysis was carried out on postoperative day 9 and the animals were fed orally on the same day on the condition that there was no esophageal leakage. The rabbits were sacrificed to measure diameters of the OR line, bursting pressure (BP), and hydroxyproline (HP) levels in the repaired cervical esophageal segment (RCES) 2 months later. RESULTS: The values of BP and HP in the C group were significantly higher than those in the L group. The diameters of the OR line in the L group were significantly greater compared to those in the C group. CONCLUSIONS: Cy glue instillation seems to be the ideal treatment for esophageal anastomosis leakages as shown by increased diameters of the OR line and decreased HP levels.

Investigation of histopathologic changes in the ureter walls in vesicoureteral reflux.

PURPOSE: This study aimed to determine the histopathologic changes in ureteral walls (UWs) in children with vesicoureteral reflux (VUR). METHODS: Twenty ureteral specimens taken from children were divided into 2 groups, refluxing (R) and control (C) groups, each containing 10 specimens. Wall thickness of the ureter, tunica muscularis of the ureter, mucosal thickness of the ureter (uroepithelium), collagen thickness of the ureter, mucosal change, and inflammation were evaluated in resected distal UWs in children with VUR. RESULTS: The mean wall thickness of the ureter, mean tunica muscularis of the ureter, and mean uroepithelium values of the UWs in the R group were not significantly lower compared to those in the C group. Collagen thickness values in the R group were significantly lower than those in the C group. CONCLUSIONS: Our data suggest that wall thickness (tunica muscularis and uroepithelium) was not significantly decreased, but collagen thickness of the ureter was decreased in the UWs of children with VUR.

An oblique anastomosis has more linear length than a transverse anastomosis of a tubular structure in oesophageal anastomosis.

INTRODUCTION: Oesophageal stricture continues to be a challenging paediatric surgical problem. This study aimed to compare the results of oblique and transverse anastomosis to prevent anastomotic stricture that occurred following oesophageal repairs. MATERIALS AND METHODS: Twelve New Zealand rabbits were divided equally into two groups: oblique (O) and transverse (T). A 1-cm-long tract of the cervical oesophagus was resected through a cervical incision in both groups. Anastomosis was performed in both groups. Oesophagographic analysis was carried out on postoperative day 7 and the animals were fed orally on the same day on the condition that there was no oesophageal leakage. The rabbits were killed to measure diameters of the oesophageal lumen and bursting pressure (BP) in the anastomosis region 8 weeks later. RESULTS: The diameters of the oesophageal anastomosis lines (3.9 +/- 0.10 mm) in the O group were significantly greater than those (1.9 +/- 0.09 mm) in the T group (P < 0.05). The values of BP (189 +/- 10 mmHg) in the O group were also significantly higher than those (116 +/- 4 mmHg) in the T group (P < 0.05). CONCLUSIONS: Our results suggested that oblique anastomosis is a better surgical procedure for preventing oesophageal stricture, as shown by the increased diameters of oesophageal anastomosis lines and BP.

Effects of melatonin on spermatogenesis and testicular ischemia-reperfusion injury after unilateral testicular torsion-detorsion.

PURPOSE: This study aimed to determine the effect of melatonin in preventing ischemia-reperfusion (I-R) injury-induced tissue damage and on spermatogenesis after experimental testicular torsion (TT). METHODS: Forty peripubertal rats were divided into 4 groups each containing 10 rats: control (C), sham (S), torsion plus detorsion (TD), and torsion plus melatonin (M). The left testes were rotated 720 degrees for 6 hours and detorsed for 6 hours thereafter. Serum inhibin B (IB) levels were measured in blood samples taken from all groups. Left orchiectomies were performed to determine the tissue levels of Johnsen's scores (JS) and malondialdehyde (MDA). RESULTS: Serum IB levels in the S and TD groups were significantly lower compared with that in the C group, whereas they were higher in the M group compared with the TD group. The MDA levels were significantly lower in the C, S, and, M groups compared with the TD group. Johnsen's scores were significantly higher in the C, S, and M groups compared with the TD group. CONCLUSIONS: Our results suggested that melatonin is a potent antioxidant agent in preventing testicular I-R injury, as shown by increased IB levels and JS.

Caudal anesthesia for minor subumbilical pediatric surgery: a comparison of levobupivacaine alone and levobupivacaine plus sufentanil.

STUDY OBJECTIVES: To compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.20% with and without the addition of sufentanil 0.5 microg kg(-1). DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PATIENTS: 40 ASA physical status I pediatric patients, aged one to 7 years, who were scheduled for elective minor subumbilical surgery. INTERVENTIONS: Patients were divided into two groups to receive either a single caudal injection of one mL kg(-1) levobupivacaine 0.20% (Group L) or levobupivacaine 0.20% plus sufentanil 0.5 microg kg(-1) (Group LS). MEASUREMENTS: Analgesia (Children and Infants Postoperative Pain Scale score), motor block (Motor Blockade Scoring), and side effects were assessed at predetermined time points during the first 24 postoperative hours. MAIN RESULTS: The Children and Infants Postoperative Pain Scale scoring at the first hour was significantly lower in Group LS than in Group L. No significant differences were found between the two groups for pain scores at two, three, 4, 5, 6, 9, 12, and 24 hours. Degree of motor block was comparable between the two groups. CONCLUSION: The effect of adding sufentanil to caudal levobupivacaine on postoperative pain scores is brief after elective minor subumbilical surgery in children.

Investigation of histopathologic changes in the ureter walls in experimental congenital obstructive uropathy.

BACKGROUND/PURPOSE: The aim of this study is to determine the histopathologic changes in the ureter wall in experimental urinary bladder hypoplasia and agenesis. METHODS: Timed pregnant rats were randomly divided and received intraperitoneal Adriamycin (ADR) at 2 mg/kg on gestational days (GD) 6 to 9 (ADR group) and saline at 2 mL/kg on GD 6 to 9 (SF group). The control (C) group did not receive any medication in their pregnancy. Fetuses were harvested near term on GD 21 and dissected under a dissecting microscope and examined for urinary system abnormalities. RESULTS: Diameter of ureter lumen was significantly increased, but wall thickness, tunica muscularis, and epithelial thickness of the ureter were decreased in the ADR group as compared with the C and SF groups. CONCLUSIONS: Diameter of the ureter lumen was increased, but wall thickness, tunica muscularis, and uroepithelium of the ureter were decreased in the ADR group in the intrauterine period. The diameter of the ureter lumen and wall thickness of ureter (tunica muscularis of ureter and uroepithelium) were increased following obstructive uropathy after the birth.